Obesity and Adaptive Strategies among American Indians Living off Reservation uses the CDCs Social Ecological Model (SEM) as well as resilience and Rapid Assessment, Response and Evaluation (RARE) approaches to investigate lifestyle changes and obesity related to physician-patient communication among American Indians living off reservation. Strategies will be designed at the community and policy levels and will inform the activities of CAIR, a local wellness policy coalition and community stakeholders. Partnerships include three agencies that serve American Indians: a CHC, an urban Indian health care center, and a hospital affiliated obesity clinic for children. Aims include: 1) Identify current knowledge, attitudes, beliefs, and behaviors among American Indians related to increased fitness and demonstrated resilience through lifestyle changes 2) Assess patient ~provider communication about overweight and obesity 3) Develop evidence-based, culturally appropriate strategies to promote healthy lifestyles and 4) Make policy and procedural recommendations. Rapid assessment will be used to conduct qualitative and quantitative research in homes and clinical settings regarding obesity diagnoses and health-seeking behaviors. Participants will include health care providers, and individuals and children (and caregivers) who have shown a marked improvement in blood pressure, A1C and/or BMI over the past two years. RARE will include the training and employment of Community Ethnographers on methods and analysis and data collection. Methods will include a combination of interviews, surveys, focus groups, and observations. At the conclusion of research and analysis Community Ethnographers will develop a set of evidence-based strategies in keeping with RARE methodology. At the conclusion of research and analysis Community Ethnographers will develop a set of evidence-based strategies in keeping with RARE methodology. Strategies will inform policy and procedural recommendations to the Center for American Indian Resilience (CAIR) Community Advisory Board, partner agencies, and American Indian people working to adopt healthy lifestyles.